Equipment for regional anesthesia in children

Pediatric pain management has started to advance over the past few decades, perhaps due to both increased recognition of suboptimal pain control in children and introduction of various advanced techniques and sophisticated equipment promising to improve accuracy with placement of needles and catheters. This chapter discusses equipment used in pediatric anesthesia and analgesia today with special emphasis on equipment used for nerve stimulation and ultrasound guidance during peripheral and central anesthesia and analgesia. Although caudal blocks remain popular for pediatric analgesia, single-shot and continuous peripheral nerve blocks will become more common due to the advances with stimulating catheters and ability to visibly monitor the procedures under ultrasound guidance. Electrical epidural (nerve root) stimulation shows great promise to increase reliability, and potentially safety, when introducing and advancing of catheters within the epidural space. Ultrasonographic guidance during peripheral and central nerve blockade is suitable for children, particularly as their nerve structures are more superficial than adults and the image resolution is greater. The ability to use ultrasound to avoid puncturing vital structures as well as to reduce local anesthetic requirements are both very beneficial in this population. Bringing high technology imaging into operating rooms is a giant leap for regional anesthesia.